Objective: The aim of this study was to describe the epidemiological and clinical profile of Kaposi’s disease (KD) from 1990 to 2020 in dermatology in Lomé (Togo). Patients and Method: This is a case series of KD including all records of patients seen as outpatients and/or hospitalised for KD of clinical and/or histological diagnosis between 1990 and 2020 in the public dermatology services of Lomé. Results: During the study period, 307 cases of KD were recorded, with a hospital frequency of 0.24%. The mean age of the patients was 40.03 ± 13.71 years, with extremes ranging from 6 to 90 years, and they were predominantly male (M/F = 1.5). The mean duration of KD before consultation was 639.96±1029.3 days (extremes: 14 to 7300 days). Skin lesions were found in 97.7% of patients (n=300). 134 (66%) and 52 (70.3%) patients with HIV-associated KD and endemic KD respectively had angiomatous nodules; 134 (66%) and 45 (60.8%) patients had infiltration. These lesions were mainly located on the right legs and feet, respectively 62.6% and 55.7% in HIV-associated KD and 51.3% and 70.3% in endemic KD. Mucosal lesions were present in 32.6% (n=100) of patients and the most common was the buccal mucosa whatever the type of KD; but more frequent in HIV-associated KD in 82 patients (40.4%). Of the 307 patients surveyed, 42 deaths were recorded (13.7%), patients surveyed, 42 deaths were recorded (13.7%), including 35 among the 203 patients with HIV-associated KD (17.2%). Conclusion: Our study shows a predominance of HIV-associated MK over the 30 years of the study. Widespread use of antiretroviral treatment with the “test and treat” strategy will help to reduce mortality.

Objective: The aim of this study was to describe the evolution of Kaposi’s disease (KD) between 1990 and 2020 in dermatology in Lomé (Togo). Patients and Method: This is a series of cases of KD including all the records of patients seen on an outpatient basis or hospitalised for KD of clinical and/or histological diagnosis between 1990 and 2000 (period of non-general introduction of ART), 2000 to 2010 (initial and increasing introduction of ART) and between 2010 and 2020 (period of general introduction of ART) in the public dermatology departments of Lomé. Results: During the study period, 307 cases of MK were recorded, with a hospital frequency of 0.24%. The mean age of the patients was 40.03±13.71 years, with extremes ranging from 6 to 90 years and a male predominance (M/F= 1.5). The overall frequencies of KD from 1990 to 2000, 2000 to 2010 and 2010 to 2020 were 0.10, 0.30 and 0.25 respectively (p=0.002) and were dominated by HIV-associated KD (66%). During the same periods, 1990 to 2000, 2000 to 2010 and 2010 to 2020, the overall incidence was 3.00, 12.20 and 14.09 respectively (p<0.0001). Of the 307 patients, 13.7% (n=42) died, the majority in the HIV-associated form of KD. Conclusion: Our study shows a significant increase in the incidence of MK over the 30 years of the study, with a predominance of HIV-associated MK. The generalized use of antiretroviral treatment with the «test and treat» strategy will help to reduce this mortality.

Introduction : La téléexpertise en dermatologie représente une piste pour modifier l’exercice médical en réponse aux besoins d’économies de la santé. Le but de cette étude était d’évaluer les activités médicales de la phase pilote du projet de téléexpertise en dermatologie au Togo. Méthode : Il s’agit d’une étude transversale menée en octobre 2020 sur les 20 sites de la phase pilote. Cette évaluation consistait en une revue documentaire et l’analyse des données postées sur la plateforme de téléexpertise. Résultats : Au total, 738 (10,8 %) des 6 810 consultations dermatologiques ont été postées sur la plateforme de téléexpertise. Sur les 738 cas, l’expertise du dermatologue n’a pas permis de poser un diagnostic dans 119 cas (16,1 %). Cette expertise a confirmé l’hypothèse clinique unique proposée par l’agent de santé dans 275 cas (37,3 %) et a permis de conclure à un diagnostic parmi plusieurs hypothèses cliniques dans 30 cas (4,1 %). Au contraire, le diagnostic du dermatologue ne figurait pas dans les hypothèses de l’agent de santé dans 201 cas (27,2 %), et aucune hypothèse clinique n’avait été formulée dans 113 cas (15,3 %). La concordance entre l’hypothèse clinique proposée par l’agent de santé et le diagnostic du dermatologue était de 48,8 %. Concernant l’acceptabilité de la téléexpertise, un seul refus a été enregistré. Tous les patients étaient très satisfaits de cette pratique. Conclusions : Les résultats montrent la faisabilité et l’acceptabilité de la téléexpertise par les personnels de santé et les patients. La concordance diagnostique de 48,8 % montre la relative efficacité de la délégation de tâches.

Introduction:Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo.Method:A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform.Results:A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist’s expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist’s diagnosis was not included in the health worker’s hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice.Conclusions:The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.

Aim The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. Patients and Method Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. Results Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lomé (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. Conclusion Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.

ObjectiveThe purpose of this study was to describe the epidemiological, clinical and therapeutic aspects as well as outcome of cutaneous sarcoidosis in Lomé (Togo). MethodsThe study is a retrospective data analysis of cutaneous sarcoidosis cases seen during a 17-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) at the dermatology departments in Lomé, Togo. ResultsIn total, 18 cases of cutaneous sarcoidosis were diagnosed; of them, 14 were females and 4 were males.The mean age of the patients was 50.9 years.Cutaneous manifestations were dominated by papules (16 cases) and scars sarcoidosis (12 cases).Locations of lesions were mainly the face (13 cases) and neck (7 cases).Extra cutaneous lesions were essentially lymph nodes (5 cases) and respiratory symptoms (4 cases).Chest X-rays was abnormal in 9 of the 14 patients in whom it had been performed.The pulmonary functional test performed in 3 patients with respiratory involvement showed a restrictive lung syndrome.A tuberculin anergy was found in 2 of the 6 patients in whom tuberculin intradermal test was performed.Patients with isolated cutaneous sarcoidosis were treated with topical corticosteroid (8 cases) or hydroxychloroquine (one case).The nine other patients were treated with oral corticosteroids, which were replaced by methotrexate after a corticodependence in 2 cases.We recorded 4 cases of clinical remission (2 cases of isolated cutaneous sarcoidosis and 2 cases of skin disease with systemic sarcoidosis).The 2 cases of skin disease with systemic sarcoidosis had recurrence 8 months and 12 months later.The remaining 14 patients were lost to follow-up after an average follow-up period of 4 months. ConclusionOur survey shows that the patterns of cutaneous sarcoidosis are similar to that reported from other sub-Saharan African countries with a few distinguishing particularities.

Le syndrome KID est une affection génétique rare associant kératite, ichtyose et surdité. Nous rapportons un cas dont la surdité s'est compliquée de mutisme chez un enfant togolais issu d'un mariage consanguin.Il s'agissait d'une fillette de 9 ans admise en dermatologie pour une peau sèche et une kératodermie palmoplantaire évoluant depuis l'enfance, une surdité sévère et un mutisme total évoluant depuis la naissance. Il n'y avait pas d'histoire familiale connue de syndrome KID. Les parents de cet enfant sont des cousins germains. A l'examen, on notait une kératodermie palmoplantaire typique en cuir grossier, une peau sèche ichtyosiforme finement squameuse avec un aspect pachydermique aux genoux et un aspect arlequin aux jambes. L'examen ophtalmologique avait noté une blépharo-conjonctivite, une xérophtalmie, une photophobie et une absence de sourcils. L'examen ORL avait objectivé une hypotrophie des pavillons des oreilles, une surdité sévère et un mutisme total. La particularité de cette observation réside dans la sévérité de l'atteinte auditive qui s'est compliquée de mutisme. Notre enfant étant née de parents consanguins sains, sans histoire familiale de KID, nous pensons que le mode de transmission est probablement sporadique. Une étude moléculaire du cas index et de ses parents, non réalisée à cause de notre plateau technique limité aurait pu le confirmer.

Abscess formation is a frequent local complication of leg erysipelas. In this study we aimed at identifying factors associated with abscess formation of leg erysipelas in patients in sub-Saharan African countries.

INTRODUCTION: Les pathologies cutanées du sujet âgé ont des manifestations cliniques qui diffèrent de celles du sujet jeune. Le but de cette étude était de déterminer les pathologies cutanées motivant une consultation du sujet âgé en dermatologie à Lomé (Togo). METHODES: Il s'agissait d'une étude transversale descriptive portant sur les nouveaux diagnostics d'affections cutanées colligés entre le 1er janvier 2010 et le 31 décembre 2011 chez les sujets âgés de 65 ans et plus en dermatologie à Lomé. RESULTATS: Durant la période d'étude, 325 patients âgés de 65 ans et plus (2,4 %) ont été examinés sur l'ensemble des 13440 patients ayant consulté en dermatologie. Ces 325 patients ont consulté pour 375 nouveaux diagnostics. L'âge moyen des patients était de 72,8 et le sex-ratio (H/F) de 0,8. Les mycoses représentaient le principal motif de consultation (18,7 %), suivies par l'eczéma (17,9 %), le prurit (13,1 %), les tumeurs (9,0 %) dont 76,5 % de tumeurs bénignes et les troubles de la kératinisation (5,1 %). Les ulcères de jambe étaient observés chez 2,1 % des patients. Les mycoses étaient essentiellement représentées par les intertrigos (52,9 %) et les dermatophyties de la peau glabre (25,7 %). La maladie de Kaposi et les chéloïdes représentaient respectivement les tumeurs malignes et bénignes les plus fréquentes. CONCLUSION: Cette étude montre une fréquence élevée des mycoses, de l'eczéma et du prurit chez les sujets âgés à Lomé. La fréquence élevée des mycoses pourrait s'expliquer par les conditions climatiques (chaleur, humidité) et celle du prurit par le vieillissement de la peau.

RésuméObjectif Cette étude a pour but de décrire les caractéristiques cliniques des patients acnéiques qui utilisent des produits de blanchiment de la peau (SB).Patients et méthodes Il s’agit d’une étude prospective menée sur une période de 8 mois dans 3 services de dermatologie et une clinique privée. Tous les patients examinés pour une acné ont été inclus dans l’étude.Résultats L’étude a inclu 119 patients examinés pour une acné, du mois de mars au mois d’octobre 2010. Parmi eux, 48 (40.7 %) procédaient à un blanchiment de la peau (SB). L’hydroquinone a été le premier produit utilisé pour le SB (26 sur 48), suivie par les corticostéroïdes locaux (17 sur 48). Les lésions élémentaires ont été les suivantes: papules (99.2 %), comédons (36.1 %), pustules (63.9 %), pigmentation (26.1 %), cicatrices (21 %) et nodules (20.2 %). L’atteinte acnéique du visage a été observée chez tous les patients (100 %). Les lésions étaient étendues chez 43.7 % des patients. L’étendue des lésions acnéiques n’a pas été statistiquement associée aux SB. Les autres régions du corps concernées ont été le thorax (20.2 %), le dos et les épaules (41.2 %). Le risque relatif de présenter des lésions sur le dos et/ou les épaules quand le patient utilisait des SB a été de 2.71 (IC: 1.08–6.84), ce qui est significatif.Conclusion L’étude suggère que le dos et les épaules peuvent constituer les principales zones de lésions acnéiques associées avec la pratique du SB. L’influence des différents types de produits n’est pas claire.

Objective. The aim of the study is to investigate the possible associations between the blood groups ABO and Rhesus systems and the presence of keloids in patients with black skin. Method. This case-control study was conducted between September 2007 and August 2011 comparing dermatologic outpatients with keloids to matched controls recruited in preanesthetic consultation at Tokoin Teaching Hospital of Lomé (Togo). Results. The distribution of different ABO blood groups and Rhesus blood groups in both groups (cases versus controls) was not significantly different. This distribution of different blood groups was superimposed on the general population of blood donors at the National Blood Transfusion Center of Lomé. Univariate analysis between each blood group and the presence of keloid does not yield any statistically significant association between blood groups and presence of keloids in the subjects. Conclusion. The study shows no significant association between blood groups and the presence of keloids in our patients. Further investigation needs to be conducted to elucidate this hypothesis further by conducting multicenter studies of several ethnic groups.

Objective This study aims at describing the clinical characteristics of patients with acne using skin bleaching (SB) products. Patients and methods This is a prospective study conducted over 8 months in three dermatology departments and one private clinic. All patients examined for acne were included in the study. Results The study included 119 patients examined for acne from March to October 2010. Among them 48 (40.7%) did SB. Hydroquinone was the first product used for SB (26 of 48), followed by topical corticosteroids (17 of 48). The elementary lesions were papules (99.2%), comedos (36.1%), pustules (63.9%), pigmentation (26.1%), scars (21%), and nodules (20.2%). The extent of acne on the face was observed in all patients (100%). The lesions were extensive among 43.7% of the patients. The extent of acne lesions was not statistically associated with SB. Other body areas concerned were the chest (20.2%), back, and shoulders (41.2%). The relative risk of having lesions on the back and/or shoulders when the patient practiced SB was 2.71 (CI: 1.086.84), which is significant. Conclusion The study suggests that the back and shoulders can be the main areas for acne lesions associated with the practice of SB. The influence of different types of product is unclear.

INTRODUCTION:The medicine dissertation is often the last step of a physician's medical studies. Long considered a rite of passage, it is now regarded as a scientific work deserving attention from the national and international scientific community. The objectives of this study were to document the means by which dissertations at the University of Lomé Medical School are diffused and to determine their impact on the scientific production of medical school faculty.METHODOLOGY:This cross-sectional study included all dissertations in medicine at the University of Lomé from 1993 through 2002. We interviewed dissertation supervisors and co-supervisors (questionnaire-structured interviews) and consulted the Medline and CNRS/PASCAL databases, scientific communication registers and local journals to collect information.RESULTS:During this period, 240 dissertations were defended at the University of Lomé medical school. More than half came from the departments of medicine (n=85, 35.4%), surgery (n=57, 23.7%) and paediatrics (n=51, 22.5%). The majority dealt with epidemiological (47 %) and clinical (35.8 %) themes, and only a small minority concerned topics in microbiology and biochemistry (7.5 %). Ninety-nine dissertations (41 %) were published: 54 (22.5%) in indexed journals and 45 (18.5 %) in non-indexed journals; 130 (54%) were delivered as papers or posters at scientific meetings. The distribution of published dissertations according to department showed that the departments of paediatrics (51.3 %), medicine (21.2 %) and surgery (21 %) had the best rates of publication in indexed journals, compared with obstetrics and gynaecology (4 %) and basic science (13.8 %) departments. During the study period, faculty at the University of Lomé medical school published 264 articles in indexed journals: dissertations accounted for only 20.4 %. Dissertations made up a higher proportion of publications in the paediatrics department (32.2 %) than in surgery (20.7 %), medicine (19.8 %), basis sciences (14 %) or obstetrics and gynaecology (3.6 %).CONCLUSION:Our study shows that the proportion of published dissertations remains small and is even smaller if we consider only those published in indexed journals (22.5 %). Dissertations also account for an insignificant proportion of the publications by medical school faculty. This raises the question of the scientific interest that the faculty accord to these dissertations.

Buts : Documenter les modes de diffusion des thèses de médecine soutenues à l'Université de Lomé et déterminer leur importance dans la production scientifique des enseignants. Méthodes : Dans le cadre d'une étude transversale qui a porté sur toutes les thèses de médecine soutenues à la faculté de médecine de l'université de Lomé au cours de la période 1993-2002, nous avons mené une enquête auprès des directeurs et codirecteurs puis consulté les bases de données Medline, CNRS/PASCAL. Résultats : Au cours de cette période d’étude 240 thèses ont été recensées. Les thèses soutenues provenaient essentiellement des départements de médecine (85 thèses), de chirurgie (57 thèses), de pédiatrie (37 thèses). Quatre-vingtdix- neuf (41 %) thèses ont été publiées dont 54 (22,5 %) dans les revues indexées et 45 (18,5 %) dans les revues non indexées ; 130 (54 %) thèses ont fait l'objet de communication. Les départements de pédiatrie (51,3 %) de médecine (21,2 %) et de chirurgie (21 %) avaient les meilleurs taux de publications. Cinquante-six thèses ont fait l'objet de protocoles pour la pratique. Au cours de la période d'étude, les enseignants de la faculté de médecine ont publié 264 articles dans les revues indexées. Les thèses ne représentaient que 20,4 % de ces publications. Conclusion : Notre étude montre que la proportion de thèses publiées dans les revues indexées reste faible. Par ailleurs, la place des thèses dans les publications des enseignants de la faculté de médecine est modeste.

AIM:To define the epidemiologic and clinical profile and course of the disease in African Kaposi's sarcoma (KS) and acquired immunodeficiency syndrome (AIDS)-associated KS in Togo. METHODS:This was a retrospective study performed on the medical records of patients seen at the Department of Dermatology, University Hospital of Lomé, Togo from January 1994 to December 2004. The medical records of all patients with KS, who had undergone human immunodeficiency virus (HIV) serology, were included in the study. RESULTS:Ninety-three files on 98 patients with KS, who had undergone HIV serology, were included in the study. The annual incidence during the study period was 8.5. HIV serology was positive in 73 patients (78.5%) and negative in 20 patients (21.5%). The mean age of the patients with AIDS-associated KS was 33.8 +/- 8.2 years, and 49.5 +/- 15.8 years for African KS. The male to female ratio for AIDS-associated KS was 1.4, and 9 for African KS. The mortality rate at 2 years for African KS was 5%, and 45% for AIDS-associated KS. CONCLUSION:The low level of access to antiretroviral drugs in HIV-infected patients explains the morbidity and mortality from AIDS-associated KS in Togo.